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Endoscopic ‘cold steel’ versus laser dacryocystorhinostomy: completing the audit cycle

Published online by Cambridge University Press:  18 December 2007

S E Lester ,
A K Robson  and
M Bearn
S E Lester*
Affiliation:
James Cook University Hospital, Middlesbrough, UK
A K Robson
Affiliation:
Cumberland Infirmary, Carlisle, England, UK
M Bearn
Affiliation:
Dr Gray's Hospital, Elgin, Scotland, UK
*
Address for correspondence: Mr S E Lester, ENT Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK. E-mail: [email protected]
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Abstract

Introduction:

Dacryocystorhinostomy via an endonasal route has been adopted in our department. This audit study describes and compares our results for external, laser endonasal and ‘cold steel’ endonasal techniques. Success was defined as a subjective report of eye watering being ‘better’ or ‘cured’. Data were obtained from a retrospective review of the medical records of all patients undergoing primary dacryocystorhinostomy in our department.

‘Gold standard’:

External dacryocystorhinostomy performed by a consultant ophthalmologist was taken as our gold standard. In our study, the success rate for external dacryocystorhinostomy was 94 per cent.

First cycle – laser-assisted endonasal dacryocystorhinostomy:

Our initial results for endonasal laser-assisted dacryocystorhinostomy produced a success rate of 64 per cent, which was significantly worse than that for external dacryocystorhinostomy. These results have been previously published.

Change in practice:

Evidence suggested that cold steel endonasal dacryocystorhinostomy was more effective, and we adopted this as our technique of choice.

Second cycle – cold steel endonasal dacryocystorhinostomy:

Over a four-year period, 57 cases completed a full nine months' follow up. 93 per cent were completed as day cases and 39 per cent were performed under local anaesthetic. The success rate was 79 per cent (45/57). There was no difference in success rates when this procedure was compared with external dacryocystorhinostomy (p = 0.55). The type of anaesthetic used (i.e. local vs general) made no difference to the success rate (p = 0.93).

Change in practice:

Cold steel endonasal dacryocystorhinostomy was as effective as the gold standard, i.e. external dacryocystorhinostomy. Laser-assisted dacryocystorhinostomy was significantly less successful than external dacryocystorhinostomy. Due to the benefits of decreased operating time, lower morbidity and success under local anaesthetic, we recommend cold steel endonasal dacryocystorhinostomy as our procedure of choice for the treatment of epiphora.

Keywords

EpiphoraDacryocystorhinostomyEndonasal
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 9 , September 2008 , pp. 924 - 927
Copyright
Copyright © JLO (1984) Limited 2007

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Footnotes

Presented in part at the ENT-UK Clinical Audit and Practice Advisory Group (CAPAG) national audit meeting, Royal College of Surgeons of England, London, UK, 6 September 2006.

References

1 McDonogh, M, Meiring, JH. Endoscopic transnasal dacryocystorhinostomy. J Laryngol Otol 1989;100:585–7CrossRefGoogle Scholar
2 Durvasula, VSP, Gatland, DJ. Endoscopic dacryocystorhinostomy: long-term results and evolution of surgical technique. J Laryngol Otol 2004;118:628–32CrossRefGoogle ScholarPubMed
3 Mirza, S, Al-Barmani, A, Douglas, SA, Bearn, MA, Robson, AK. A retrospective comparison of endonasal KTP laser dacryocystorhinostomy versus external dacryocystorhinostomy. Clin Otolaryngol 2002;27:347–51CrossRefGoogle ScholarPubMed
4 Bartly, GB. The pros and cons of laser dacryocystorhinostomy. Am J Opthalmol 1994;117:103–6CrossRefGoogle Scholar
5 Malhotra, R, Wright, M, Olver, JM. A comparison of the time taken to do dacryocystorhinostomy (DCR) surgery. Eye 2003;17:691–6CrossRefGoogle Scholar
6 National Institute of Clinical Excellence. Endoscopic Dacryocystorhinostomy, IP022. London: National Institute of Clinical Excellence, 2004Google Scholar
7 National Institute of Clinical Excellence. Endoscopic Dacryocystorhinostomy, IP 113. London: National Institute of Clinical Excellence, 2005Google Scholar
8 Sadiq, SA, Ohrlich, S, Jones, NS, Downes, RN. Endonasal laser dacryocystorhinostomy – medium term results. Br J Opthalmol 1997; 81:1089–92CrossRefGoogle ScholarPubMed
9 Hartikainen, J, Antila, J, Varpula, M, Puukka, P, Seppa, H, Grenman, R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope 1998;108:1861–6CrossRefGoogle ScholarPubMed
10 Mathew, MR, McGuiness, R, Webb, LA, Murray, SB, Esakowitz, L. Patient satisfaction in our initial experience with endonasal endoscopic non-laser dacryocystorhinostomy. Orbit 2004;23:77–85CrossRefGoogle ScholarPubMed
11 Mann, BS, Wormald, PJ. Endoscopic assessment of the dacryocystorhinostomy after endoscopic surgery. Laryngoscope 2006;116:1172–4CrossRefGoogle ScholarPubMed
12 Mortimore, S, Banhegy, GY, Lancaster, JL, Karkanevatos, A. Endoscopic dacryocystorhinostomy without silicone stenting. J R Coll Surg Edinb 1999;44:371–3Google ScholarPubMed
13 Mahendran, S, Stevens-King, A, Yung, MW. How we do it: the viability of free mucosal grafts on exposed bone in lacrimal surgery – a prospective study. Clin Otolaryngol 2006;31:324–7CrossRefGoogle Scholar
14 Wormald, PJ, Tsirbas, A. Investigation and endoscopic treatment for functional and anatomical obstruction of the nasolacrimal duct system. Clin Otol 2004;29:352–6CrossRefGoogle ScholarPubMed